Incidence, Risk Factors, and Outcome of Ceramic-On-Ceramic Bearing Breakage in Total Hip Arthroplasty

Research and Application of Chitosan Nanoparticles in Orthopedic Infections

Orthopedic infection is one of the most intractable orthopedic problems. Bacteria resistant to antibiotics also develop gradually. Chitosan is widely used in the Biomedical field because of its high biocompatibility, biodegradability, and antibacterial activity. Chitosan-based drug delivery systems are frequently utilized to produce controlled medication release. When combined with antibiotics, synergistic antibacterial effects can be achieved. Chitosan-based nanoparticles are one of the most widely used applications in drug delivery systems. The focus of this review is to provide information on new methods being developed for chitosan-based nanoparticles in the field of bone infection treatment, including chitosan nanoparticles for antibacterial purposes, Ch-loaded with antibiotics, Ch-loaded with metal, and used as immune adjuvants. It may Provide ideas for the fundamental research and the prospects of future clinical applications of orthopedic infections.

Ceramic fragmentation after total hip arthroplasty: two case reports and literature review

Background

Ceramic fragmentation is a rare but serious complication after total hip arthroplasty (THA). We reviewed the PubMed literature from 1990 to 2023 and found only 31 case reports of ceramic fragmentation after THA. Our case reports help to expand understanding of this rare complication. We shared our surgical experience and identified an ideal material for revision surgery, which can serve as a useful reference for other orthopedic surgeons to perform ceramic fragmentation revision surgery in the future. We also analyzed the possible causes, diagnosis, and treatment opinions of ceramic fragmentation.

Case presentation

This study presents two cases of ceramic fragmentation after THA. One patient had ceramic head fragmentation 10 years after the primary THA, and one patient had ceramic liner fragmentation 5 years after the primary THA. Both patients presented with pain, and one patient also reported a clicking sound in the hip. The two patients described here had BMIs of 23.7 and 23.1, respectively. Both patients' ceramic fragmentation were due to aseptic loosening, not periprosthetic joint infections, as confirmed by negative microbiological cultures. Radiographic examinations of both patients revealed radio-opaque wear debris around the hip joint prostheses and we describe the surgical protocols and intraoperative findings in both cases in detail.

Conclusion

Our cases and the literature suggest that ceramic fragmentation can occur at any time after THA. The most immediate symptoms are pain and noise, but some patients may be asymptomatic. Ceramic on polyethylene bearings is recommended for revision surgery whenever possible; metal bearings should be avoided.

Ceramic-related noise as an adverse outcome in total hip arthroplasty

Introduction Ceramic hip replacement bearings have shown to be low wearing and biocompatible. The last two generations of Biolox Forte and Biolox Delta ceramics have have established themselves as durable bearings. However, squeaking and noise from ceramic bearing THRs is well recognised in the 21st century.

The objective was to explore the problem of noise in the ceramic bearing of THA based on the analysis of the foreign and Russian literature.

Material and methods In presented the analysis of Foreign and Russian literature searches for the review were produced according to PRISMA recommendations using PubMed, Scopus, Google Scholar, eLibrary. MINOR was used to assess the methodological quality of articles.

Results and Discussion Noise in ceramics is observed in 37.7 %. There are many theories on the origin and mechanism of noise including liner impingement and loading, film disruption, third body, microseparation and resonance. However, there is still no consensus on what is noise in the ceramic bearing and how to solve this problem.

Conclusion Literature review of ceramic bearing indicated enough unanswered questions. The noise may play a role as a predictor of improper use of endoprosthesis with accumulated database resulting in better understanding of the phenomenon, methods of the correction and timely prevention of ceramic breakage.

Fracture of a Metal-Backed Ceramic Liner After Total Hip Arthroplasty: A Case Report

Total hip arthroplasty (THA) is a common procedure that has become increasingly prevalent in a younger patient population. With improvements in prostheses and materials, the survivorship of implants has increased. Historically, the excellent wear characteristics of ceramic-on-ceramic (CoC) implants made them an appealing choice compared to other bearing options. Yet, the potential benefits of the bearing longevity related to the wear characteristics have been combated by their unique causes of failure such as implant fracture and squeaking. Metal-backed ceramic liners were developed to minimize impingement-related chipping at the periphery of the implant that may propagate to catastrophic implant fracture. We report a case involving a fracture of a metal-backed ceramic liner that presented with months of pain and crepitus with no overt signs of fracture on imaging.

Damage analysis of retrieved BioloxⓇdelta components used in hard and soft bearings

This retrieval study included 43 Biolox delta explants (18 CoC, 25 CoP). Implants were examined macroscopically, whereby damage was evaluated using a semi quantitative scoring system. Confocal microscopy was used to examine wear related damage patterns of the articulating surfaces. Scanning electron microscopy (SEM) with energy-dispersive X-ray spectroscopy (EDS) was used to analyze wear marks on the implant surface and wear debris in periprosthetic tissue samples. Raman spectroscopy and X-ray diffraction (XRD) were used to quantify monoclinic zirconia fractions. On all components, in vivo wear resulted predominantly in different damage patterns caused by metal transfer. In CoC bearings stripe wear was additionally detected, and some implants underwent severe damage due to component breakage. The wear scores were higher for CoC components, with no differences between the scores for CoC heads and liners. Wear features caused comparable roughening on implants from CoC and CoP bearings. SEM studies demonstrated that most wear marks were caused by metal debris released from implant components. Grain pull-out was observed in stripe wear regions. Monoclinic phase shift was observed in a similar quantity on components from CoP and CoC bearings. The increase of monoclinic zirconia content around metal deposits was minimal and was more pronounced in areas of stripe wear. The results of this study indicate, that ZTA components in general undergo minimal wear in both, CoC and CoP bearings, however, it is more pronounced in the former. Metal deposits, as the most common wear feature, have no significant effect on monoclinic phase transition. STATEMENT OF SIGNIFICANCE: In this paper, we classify all damage patterns macroscopically according to an established scoring system and assess them regarding surface roughness (confocal microscopy) and monoclinic phase content (Raman spectroscopy) in order to derive the severity for patients. We compare hard-hard and hard-soft bearings and relate damage patterns with metal transfer based on SEM/EDS examinations. Furthermore, we work out correlations between patient-specific data, cause of revision and the physical condition of each individual sample Our cohort consists of 43 Biolox delta retrievals, a comparatively large quantity. In addition, we address current topics such as metal transfer and, based on the classification of damage patterns, provide incentives and/or meaningful focal points for further research.

18F-FDG and 68 Ga-FAPI PET/CT for the evaluation of periprosthetic joint infection and aseptic loosening in rabbit models

Purpose

We built a joint replacement loosening model based on the original rabbit model of infection and evaluated the performance characteristics of ¹⁸F-FDG and ⁶⁸ Ga-FAPI in evaluating infection and loosening.

Methods

After surgery, the rabbits were divided into four groups, with six individuals in the control group and 10 each in the aseptic loosening, S. aureus and S. epidermidis groups. PET/CT and serological examination were performed three times at two-week intervals. After the rabbits were euthanized, micro-CT, tissue pathology, pullout tests and scanning electron microscopy (SEM) were performed.

Results

The pullout test and SEM showed the feasibility of the aseptic loosening model. ¹⁸F-FDG showed similar performance in the control and loosening groups. The SUVmax of the S. aureus group was consistently higher than that of the S. epidermidis group. As for ⁶⁸ Ga-FAPI, the SUVmax of the control group was lowest in the second week and gradually increased over subsequent weeks. The SUVmax of the loosening group began to exceed that of the control group after the second week. The SUVmax of the S. aureus group in the second week was the lowest among the four groups and increased as the number of weeks increased. The pathology results showed concordance with the performance of PET/CT. Linear regressions between SUVmax and serology showed that ¹⁸F-FDG was positively correlated with CRP and IL-6, while ⁶⁸ Ga-FAPI revealed negative correlations with CRP and IL-6 in the second week and positive correlations in the sixth week. In addition, the SUVmax and MT(target)V of both ¹⁸F-FDG and ⁶⁸ Ga-FAPI were negatively correlated with bone volume/trabecular volume (TV) and bone surface area/TV.

Conclusion

In this longitudinal observation, ⁶⁸ Ga-FAPI showed greater sensitivity than ¹⁸F-FDG in detecting diseases, and ⁶⁸ Ga-FAPI had no intestinal or muscular uptake. The MT(target)V of ⁶⁸ Ga-FAPI was larger than that of ¹⁸F-FDG, which meant that ⁶⁸ Ga-FAPI had the potential to define the scope of lesions more accurately. Finally, the SUVmax of ⁶⁸ Ga-FAPI could not differentiate between loosening and infection; further study of the diagnostic criteria is warranted.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12891-022-05537-w.

Surgeons’ Awareness and Impaction Technique of a Ceramic Liner into a Metal Shell

Background

In ceramic-on-ceramic total hip arthroplasty, firm locking is necessary between a ceramic liner and an acetabular metal shell to prevent dissociation of the liner from the metal shell. We evaluated surgeons’ awareness of the technique for inserting the ceramic liner and measured the impaction force applied by surgeons during the insertion of the ceramic liner.

Methods

To evaluate the awareness, we conducted a survey using a questionnaire including techniques for ceramic liner insertion. The impaction force was measured using an impaction simulator in 224 surgeons.

Results

Most surgeons answered that they cleaned and dried up the inner surface of the metal shell before inserting a ceramic liner (96.4% and 86.2%, respectively), and 74.6% checked the correct seating of the ceramic liner. However, only 23.2% correctly answered that a minimum of 2kN (a light strike) was necessary to obtain a sufficient fit between the metal shell and the ceramic liner. The impaction force was weaker than 2 kN in 9.4% of the surgeons.

Conclusions

Education about the adequate impaction force to obtain a firm fit of the ceramic liner is necessary for surgeons who perform total hip arthroplasty using ceramic-on-ceramic bearings.